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Mehmed M, Walters B, Keys H, Hnynn Si PE, Athavale N, Abdelhafiz AH. Spontaneous retropharyngeal abscess presenting as delirium in a frail older woman: a case-based review. Hosp Pract (1995) 2024; 52:39-45. [PMID: 38466020 DOI: 10.1080/21548331.2024.2329043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/07/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Retropharyngeal abscess (RPA) is an uncommon infection in older people, which usually presents with localized upper airway symptoms. CASE PRESENTATION We present a case of RPA in a 69-year-old frail woman with co-morbidities, who presented atypically with delirium. She initially complained of general symptoms of malaise, body aches and general decline. Her symptoms progressed to hypoactive delirium before she started to localize her complaints to the upper airway. The delirium presentation of RPA is not commonly reported in the literature. Co-morbidities and frailty are likely to be the underlying risk factors for delirium presentation in this case. Most of the RPA cases reported in older people in the literature presented typically with localized symptoms, however these cases had lower burden of morbidities and reported no frailty. In our case report, poor mouth hygiene and dental caries were thought to be the source of infection. Early intervention with antibiotic treatment for total of four weeks resulted in a full recovery. CONCLUSION RPA may present with delirium in older people with frailty and co-morbidities. Poor oral hygiene and dental caries, if left untreated, may progress into serious deep space neck infection.
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Affiliation(s)
- Melisa Mehmed
- Department of Internal Medicine, Rotherham General Hospital, Rotherham, UK
| | - Ben Walters
- Department of Internal Medicine, Rotherham General Hospital, Rotherham, UK
| | - Heather Keys
- Department of Internal Medicine, Rotherham General Hospital, Rotherham, UK
| | - Pann Ei Hnynn Si
- Department of Internal Medicine, Rotherham General Hospital, Rotherham, UK
| | | | - Ahmed H Abdelhafiz
- Department of Internal Medicine, Rotherham General Hospital, Rotherham, UK
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Does computed tomography-guided percutaneous catheter drainage is effective for spinal tuberculous abscess: a midterm results. Spinal Cord Ser Cases 2022; 8:19. [PMID: 35132064 PMCID: PMC8821638 DOI: 10.1038/s41394-022-00488-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. PURPOSE To evaluate an effectiveness and report a midterm clinical outcome in pain and neurological status in spinal tuberculous abscess after treated by CT-guided percutaneous catheter drainage. OVERVIEW OF LITERATURE Spinal tuberculosis is one of the destructive forms of tuberculosis infection, which can cause undesirable consequences. The gold standard of surgical treatment of spinal tuberculosis with tuberculous abscess is radical debridement, abscess drainage, and bone grafting of the defect via anterior approach. However, this treatment may lead to several serious complications. CT-guided percutaneous catheter drainage is an alternative procedure for this condition and may reduce the serious complications from standard surgical treatment. MATERIALS AND METHODS The medical record of the patients with spinal tuberculosis with tuberculous abscess who underwent CT-guided percutaneous catheter drainage (CT-guided PCD) from 2015 to 2021. The visual analog pain scale (VAS), Frankel grading scale, duration of drainage, amount of spinal tuberculous abscess, and complications were evaluated. RESULTS Twenty-nine patients (mean age 44 years old) were included in the study. All patients were followed up for 24 to 72 months with an average of 36 months. Level involvements were mostly found in L1-L2 followed by L2-L3 and T12-L1 levels. A 14-Fr catheter was the mostly use followed by 16-Fr catheter. Amount of abscess drainage ranged from 110 to 2,490 ml (mean 599 ml). The drainage duration ranged from 6 to 42 days (mean 17 days). Additional surgery was performed in three patients due to subsequent mechanical instability developed despite successful drainage of abscess. At the last follow-up, VAS, Frankel grading scale were improved significantly in all patients without complications. CONCLUSIONS CT-guided percutaneous catheter drainage is a safe and effective alternative procedure in the treatment of spinal tuberculous abscess patients with high success rate, less complications, and satisfied midterm outcomes.
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Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, Fiadjoe JE, Greif R, Klock PA, Mercier D, Myatra SN, O'Sullivan EP, Rosenblatt WH, Sorbello M, Tung A. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022; 136:31-81. [PMID: 34762729 DOI: 10.1097/aln.0000000000004002] [Citation(s) in RCA: 364] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care; Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.
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Rachdi I, Fekih Y, Daoud F, Aydi Z, Ben Dhaou B, Boussema F. Cervical Pott's disease revealed by retropharyngeal abcess. Presse Med 2018; 47:918-921. [PMID: 30282586 DOI: 10.1016/j.lpm.2018.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 06/20/2018] [Accepted: 08/29/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Imène Rachdi
- University Tunis el Manar, Habib Thameur Hospital, Faculty of Medicine of Tunis, Internal Medicine Department, Ali-Ben-Ayed Street, Montfleury, 1008 Tunis, Tunisia.
| | - Yosra Fekih
- University Tunis el Manar, Habib Thameur Hospital, Faculty of Medicine of Tunis, Internal Medicine Department, Ali-Ben-Ayed Street, Montfleury, 1008 Tunis, Tunisia
| | - Fatma Daoud
- University Tunis el Manar, Habib Thameur Hospital, Faculty of Medicine of Tunis, Internal Medicine Department, Ali-Ben-Ayed Street, Montfleury, 1008 Tunis, Tunisia
| | - Zohra Aydi
- University Tunis el Manar, Habib Thameur Hospital, Faculty of Medicine of Tunis, Internal Medicine Department, Ali-Ben-Ayed Street, Montfleury, 1008 Tunis, Tunisia
| | - Besma Ben Dhaou
- University Tunis el Manar, Habib Thameur Hospital, Faculty of Medicine of Tunis, Internal Medicine Department, Ali-Ben-Ayed Street, Montfleury, 1008 Tunis, Tunisia
| | - Fatma Boussema
- University Tunis el Manar, Habib Thameur Hospital, Faculty of Medicine of Tunis, Internal Medicine Department, Ali-Ben-Ayed Street, Montfleury, 1008 Tunis, Tunisia
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Samanta S, Samanta S, Aggarwal R, Soni KD. Airway compromise during central venous cannulation in an undiagnosed tubercular retropharyngeal abscess: a case report. Ann Card Anaesth 2016; 18:596-8. [PMID: 26440253 PMCID: PMC4881684 DOI: 10.4103/0971-9784.166483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Central venous cannulation is often associated with complications during insertion even by expert's hand and with the aid of ultrasound. We encountered a patient for central line insertion through the right internal jugular vein having a retropharyngeal abscess of tubercular origin. We accidentally punctured the abscess cavity leading to increased respiratory distress and subsequent need of intubation to the patient. This kind of complication during central line insertion has never been reported before. We intend to report such a case to alert everyone about the grave complications it can lead to and the methods to minimize them in the times ahead.
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Affiliation(s)
- Sujay Samanta
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Deepti BS, Munireddy M, Kamath S, Chakrabarti D. Cervical spine tuberculosis and airway compromise. Can J Anaesth 2016; 63:768-9. [PMID: 26739698 DOI: 10.1007/s12630-015-0575-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 12/07/2015] [Accepted: 12/16/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- B S Deepti
- Department of Neuroanesthesia, National Institute of Mental Health and Neuro Sciences, Bangalore, India.
| | - Manjunath Munireddy
- Department of Neuroanesthesia, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Sriganesh Kamath
- Department of Neuroanesthesia, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Dhritiman Chakrabarti
- Department of Neuroanesthesia, National Institute of Mental Health and Neuro Sciences, Bangalore, India
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Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, Hagberg CA, Caplan RA, Benumof JL, Berry FA, Blitt CD, Bode RH, Cheney FW, Connis RT, Guidry OF, Nickinovich DG, Ovassapian A. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2013; 118:251-70. [PMID: 23364566 DOI: 10.1097/aln.0b013e31827773b2] [Citation(s) in RCA: 1157] [Impact Index Per Article: 105.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AbstractSupplemental Digital Content is available in the text.
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Affiliation(s)
- Jeffrey L Apfelbaum
- American Society of Anesthesiologists, 520 N. Northwest Highway, Park Ridge, IL 60068–2573, USA
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Harkani A, Hassani R, Ziad T, Aderdour L, Nouri H, Rochdi Y, Raji A. Retropharyngeal abscess in adults: five case reports and review of the literature. ScientificWorldJournal 2011; 11:1623-9. [PMID: 22125422 PMCID: PMC3201680 DOI: 10.1100/2011/915163] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 05/31/2011] [Accepted: 06/03/2011] [Indexed: 11/25/2022] Open
Abstract
Retropharyngeal abscesses are rare in adults. They occur mostly in immunocompromised patients or as a foreign body complication. We report 5 cases of retropharyngeal abscess collected in the ENT Department of CHU Mohammed VI of Marrakech, during a two-year period (December 2008 to December 2009). Local trauma by foreign body ingestion was the aetiology in four patients. The presenting symptoms, for all patients, were fever, odynophagia, torticollis, and trismus, and the clinical examination showed bulging of the posterior wall of the oropharynx. The radiography of cervical spine showed prevertebral thickening in all cases, this thickening was associated with an aspect of vertebral lysis of the fourth cervical vertebra in one case. A CT scan was performed in all our cases and showed features of retropharyngeal abscess which was associated, in one case, with spondylodiscitis. The biological assessment found one case of diabetes. The intradermal reaction to the tuberculin was clearly positive in one case. Endobuccal abscess puncture was practiced in 4 cases; only one organism was identified by culture: Staphylococcus aureus treatment was based on triple intravenous antibiotics and anti-Koch's therapy (in one case), and the surgical drainage under general anesthesia was also performed in the case of the diabetes patient which required also the correction of hyperglycemia in intensive care unit. The outcome was good in all our patients. The diagnosis of retropharyngeal abscess can be difficult and one must seek a comorbidity; a tuberculosis aetiology must be considered in countries with a high prevalence. The management of these cases is based on antibiotics and surgical drainage.
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Affiliation(s)
- A Harkani
- ENT Department, CHU Mohammed VI, Marrakech 4000, Morocco.
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Diom E, Ndiaye C, Djafarou A, Ndiaye I, Faye P, Tall A, Ndiaye M, Diallo B, Diouf R, Diop E. A case of cervical Pott's disease revealed by parapharyngeal abscess. Eur Ann Otorhinolaryngol Head Neck Dis 2011; 128:151-3. [DOI: 10.1016/j.anorl.2010.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 12/12/2010] [Accepted: 12/14/2010] [Indexed: 11/26/2022]
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Abstract
Airway obstruction associated with Pott's disease is rare. We present a case of severe airway obstruction caused by an extensive paravertebral mediastinal abscess in a 3-year-old boy with tuberculosis of the thoracic spine.
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Affiliation(s)
- Theresa J Ochoa
- Department of Pediatrics, Universidad Peruana Cayetano Heredia, Lima, Perú.
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Schoenhage KO, Koenig HM. Unanticipated Difficult Endotracheal Intubations in Patients with Cervical Spine Instrumentation. Anesth Analg 2006; 102:960-3. [PMID: 16492859 DOI: 10.1213/01.ane.0000194446.18696.eb] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present two cases of unanticipated difficult airway in patients requiring reoperation after cervical spine instrumentation. In both cases, the upper airway examination was normal, and fiberoptic-guided intubation proceeded with the patient sedated and breathing spontaneously. Cord visualization was difficult, but the scope was eventually advanced into the trachea and the endotracheal tube placed safely. Later review of radiographs showed the previously unrecognized protrusion of cervical hardware into the meso- and hypopharynx. We recommend that anesthesiologists review recent radiographic studies for potential airway compromise before approaching the airway of patients presenting for revision of cervical instrumentation.
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Affiliation(s)
- Kai O Schoenhage
- Department of Anesthesiology, University of Illinois at Chicago, USA
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Wong DT, Fehlings MG, Massicotte EM. Anterior cervical screw extrusion leading to acute upper airway obstruction: case report. Spine (Phila Pa 1976) 2005; 30:E683-6. [PMID: 16284580 DOI: 10.1097/01.brs.0000186861.82651.00] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report of late postoperative complication. SUMMARY OF BACKGROUND DATA There have been a number of reports of migration and extrusion of cervical fusion instrumentation. The majority of such cases have a benign outcome. To our knowledge, cervical instrumentation extrusion resulting in prevertebral abscess and acute airway obstruction has not been reported. METHODS A 56-year-old man who had undergone a prior C3-C6 anterior cervical decompression and fusion presented to a hospital with dysphagia and acute airway obstruction requiring an emergency tracheostomy. His neck radiograph showed that a C6 screw was missing compared to prior films. Magnetic resonance imaging showed a large prevertebral abscess anterior to C2-C7 causing complete upper airway obstruction. RESULTS He underwent surgical drainage of the abscess and had a good neurologic recovery. CONCLUSIONS We report a case of acute upper airway obstruction from prevertebral abscess, likely secondary to a loosened anterior cervical screw penetrating the prevertebral soft tissue. In contrast to case reports in the literature involving instrumentation extrusion with a usually benign outcome, our case presented with a life-threatening condition.
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Affiliation(s)
- David T Wong
- Division of Neurosurgery, Department of Anesthesiology, University of Toronto, Ontario, Canada.
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Wang D. Diagnosis of tuberculous vertebral osteomyelitis (TVO) in a developed country and literature review. Spinal Cord 2005; 43:531-42. [PMID: 15838529 DOI: 10.1038/sj.sc.3101753] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
STUDY DESIGN Review of medical and radiological records and literature to study the diagnosis of tuberculous vertebral osteomyelitis (TVO) and the differential diagnosis between TVO and pyogenic vertebral osteomyelitis (PVO). OBJECTIVE To identify the correct criteria for the diagnosis. SETTING National Spinal Injuries Centre, UK. METHODS (1) Medical and radiological records of 10 patients diagnosed as vertebral osteomyelitis and treated elsewhere but later admitted to the NSIC were reviewed retrospectively. (2) Medical literature on vertebral osteomyelitis were reviewed. RESULTS (1) Case review: Before the study, four of the 10 patients TVO had been diagnosed based on positive bacteriology. Of the other six, the diagnosis of PVO had been made in one based on positive blood culture of staphylococcus while in another without any positive result of bacteriology. The diagnosis had been uncertain in four because of negative results of both bacteriology and histology on both tuberculous and pyogenic infection. The author made the diagnosis of TVO in all 10 cases based on clinical manifestations and plain radiographs. Highly raised ESR with moderate rise of or normal WBC in eight cases supported TVO. Computer tomography and magnetic resonance imaging did not contribute to the differential diagnosis. Laminectomy in five patients led to some clinical improvement. The five patients without surgery deteriorated. Two of them died. (2) LITERATURE REVIEW: A total of 188 articles were reviewed. The crucial role of plain radiographs in the diagnosis of TVO and the high incidence of false-negative of tuberculosis in both bacteriological and histological tests were neglected in most articles. Polymerase chain reaction (PCR) was more reliable in diagnosing tuberculosis. CONCLUSION Clinical manifestations, discrepancy between ESR and WBC, plain radiographs and PCR are keys to a correct diagnosis of TVO.
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Affiliation(s)
- D Wang
- The National Spinal Injuries Centre (NSIC), Stoke Mandeville Hospital (SMH), Aylesbury, Buckinghamshire, UK
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Spinal Tuberculosis. Tuberculosis (Edinb) 2004. [DOI: 10.1007/978-3-642-18937-1_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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